Exploring Older Adult ED Fall Patients’ Understanding of Their Fall: A Qualitative Study

Abstract

Objective:We sought to understand older patients’ perspectives about their fall, fall risk factors, and attitude toward emergency department (ED) fall-prevention interventions.Methods:We conducted semistructured interviews between July 2015 and January 2016 of community-dwelling, nondemented patients in the ED, who presented with a fall to an urban, teaching hospital. Interviews were halted once we achieve thematic saturation with the data coded and categorized into themes.Results:Of the 63 patients interviewed, patients blamed falls on the environment, accidents, a medical condition, or themselves. Three major themes were generated: (1) patients blamed falls on a multitude of things but never acknowledged a possible multifactorial rationale, (2) patients have variable level of concerns regarding their current fall and future fall risk, and (3) patients demonstrated a range of receptiveness to ED interventions aimed at preventing falls but provided little input as to what those interventions should be.Conclusions:Many older patients who fall do not understand their fall risk. However, based on the responses provided, older adults tend to be more receptive to intervention and more concerned about their future fall risk, making the ED an appropriate setting for intervention.

Emergency department falls: a longitudinal analysis of revisits and hospitalisations between patients who fall and patients who did not fall

“…Often, fallers may minimise their reason for falling and are reluctant to engage in fall prevention efforts on their own. 10 Also, most EDs do not do a comprehensive fall evaluation, thus missing many opportunities to address the risk factor that lead to the fall or prevent future falls. 11 12 Although this study does not delineate the underlying reason for a fall or reason for their return ED visit, our findings suggest that this patient population warrants close evaluation, workup and follow-up to assess their reasons for falling and potential intervention.…”

“… 16 While the most recent randomized trial of multifactorial strategies did not show a benefit for community-based falls prevention for at-risk individuals, it did not assess prevention activities for ED patients after a fall and it also acknowledges that behaviour modification through exercise, one of the most important interventions for future fall prevention, was not underscored. 17 18 Qualitative data indicates that patients who present to the ED may have more willingness for falls prevention 10 and programmes should continue to capitalise on this motivation for secondary fall prevention strategies. 19 Further studies should also look at the cause of falls and patients’ associated comorbidities as indicators for outcomes.…”

Stand Up and Fight Falls: Can a Video Intervention Help Reduce Falls in the Geriatric Population?

“…This suggests that most patients find certain behavioral changes, such as wearing proper footwear and hydrating more, applicable. This also follows the idea that the ED is an ideal location to approach patients and present new information, as the fall is fresh in the patients’ minds and they are more receptive to new advice [ 10 ]. It suggests that further studies aimed at ED-based education initiatives focused on behavior change and preventative interventions would be worth pursuing.…”

“…One study found that patients believe their fall was caused by the environment, or by their own inattention, and did not recognize the multifactorial nature of falling. This same study also demonstrated that 41% of participants were “not concerned” about their risk of falls or recurrent falls [ 10 ]. In another study, 85% of fall patients reported that their fall was preventable [ 9 ].…”

“…In another study, 85% of fall patients reported that their fall was preventable [ 9 ]. Some studies show that patients in the community largely find fall prevention information “unnecessary, irrelevant, or inappropriate” [ 11 ]; however, another study conducted in the ED reported that patients believe that interventions based on “advice and counseling” would be welcome and effective [ 10 ]. This creates a unique opportunity for ED providers who can use the patient encounter as a teachable moment, especially if short, impactful interventions can be designed and implemented [ 12 ].…”